Medicare is a federal health insurance program for US citizens and permanent legal residents. Medicare is available to people 65 years of age and older, but those with qualifying disabilities can also receive Medicare benefits.
Original Medicare includes Part A and Part B. You can join a separate Medicare drug plan (Part D). You can use any doctor or hospital that takes Medicare, anywhere in the U.S. To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also buy supplemental coverage, like Medicare Supplement Insurance (Medigap), or have coverage from a former employer or union, or Medicaid.
Part A
Hospital Insurance
Helps cover:
Part B
Medical Insurance
Helps cover:
Part D
Drug Coverage
Helps cover:
Also known as Part C
Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These "bundled" plans include Part A, Part B, and can include Part D coverage.
Annual Election Period
Medicare Members can make new plan choices: MA to MA, MA to Med Supp/PDP, Med Supp/PDP to MAPD. The effective date of new changes is January 1.
Medicare Open Enrollment
Any MA plan members may change their MA plans or disenroll from an MA plan and return to Original Medicare with or without a stand-alone Part D plan. Members cannot move from Original Medicare to an MA plan during this time. Plan changes take effect on the first day of the following month.
Special Election Period
Qualifying Members can make changes outside of AEP in accordance with applicable requirements. In some instances, there are exceptions to the timeframe for LIS and Dual Special Needs Plans Members.
Initial Enrollment Period
Qualifying members have a seven (7) month window to enroll into an MA, MAPD, Med Supp, or PDP plan or stay with Original Medicare (Part A and B). This period spans 3 months prior to and 3 months after Medicare eligibility, or the month a person turns 65.
Special Needs Plans are a type of Medicare Advantage plan designed to serve the needs of specific groups of people. SNPs limit membership to people with specific diseases or characteristics and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
For people with severe or disabling chronic conditions such as diabetes, cardiovascular disorders, chronic heart failure, end-stage renal disease (ESRD), HIV/AIDS, chronic lung disorders, autoimmune disorders, and neurological disorders.
For people who are entitled to both Medicare and Medicaid. D-SNPs coordinate Medicare and Medicaid benefits and may offer additional benefits beyond what Original Medicare covers.
For people who live in an institution (like a nursing home) or who require nursing care at home. I-SNPs are designed to coordinate care for people who need a high level of medical care.
Who qualifies? To join a Special Needs Plan, you must have Medicare Part A and Part B, and meet the plan's specific eligibility requirements. SNPs are only available in certain areas — contact us to find out which plans are available near you.
If you have limited income and resources, you may be able to get help paying for your Medicare costs. Several programs exist at both the federal and state level to assist Medicare beneficiaries with premiums, deductibles, and co-payments.
Medi-Cal (California Medicaid)
California residents with limited income may qualify for Medi-Cal, which can work alongside Medicare to cover costs Medicare doesn't pay. Contact your local county social services office or visit dhcs.ca.gov to apply.
Medicare Supplement plans (Medigap) fill in the gaps when using original Medicare. With original Medicare the beneficiary is responsible for all co-pays, co-insurance and deductibles. With a supplement plan, these can be taken care of. These plans are administered through private insurance carriers. There is a monthly premium associated with these plans.
When a Medicare beneficiary is initially eligible for Medicare that person can enroll into a Medicare Supplement without having to go through medical underwriting. However, if a newly eligible Medicare beneficiary decides on a Medicare Advantage plan first but changes his or her mind later down the road then that person will be subject to medical underwriting. During underwriting, the insurance company makes an assessment of the beneficiary's health status and medical history to determine if they can offer a Medicare Supplement plan and at what premium rate.
Note: You cannot be on Medicaid and a Medicare Supplement at the same time.
You get a 6 month "Medigap Open Enrollment" period, which starts the first month you have Medicare Part B and you're 65 or older. During this time, you can enroll in any Medigap policy and the insurance company can't deny you coverage due to pre-existing health problems. After this period, you may not be able to buy a Medigap policy, or it may cost more. Your Medigap Open Enrollment Period is a one-time enrollment. It doesn't repeat every year, like the Medicare Open Enrollment Period.
| Plan | Key Benefits Covered |
|---|---|
| Plan A | Basic Benefits |
| Plan B | Basic BenefitsPart A Deductible |
| Plan C | Basic BenefitsSkilled NursingPart A DeductiblePart B DeductibleForeign Travel |
| Plan D | Basic BenefitsSkilled NursingPart A DeductibleForeign Travel |
| Plan F | Basic BenefitsSkilled NursingPart A DeductiblePart B DeductiblePart B ExcessForeign Travel |
| Plan G | Basic BenefitsSkilled NursingPart A DeductiblePart B ExcessForeign Travel |
| Plan K | Basic Benefits (50%)Skilled Nursing (50%)Part A Deductible (50%)Out-of-Pocket Limit |
| Plan L | Basic Benefits (75%)Skilled Nursing (75%)Part A Deductible (75%)Out-of-Pocket Limit |
| Plan M | Basic BenefitsSkilled NursingPart A Deductible (50%)Foreign Travel |
| Plan N | Basic BenefitsSkilled NursingPart A DeductibleForeign TravelCo-pays may apply |
Plans A thru N * Check with your broker or agent for updated plans
Please reach us at 909-530-0816 if you cannot find an answer to your question.
CMS Disclaimer
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or call 1-800-MEDICARE to get information on all of your options.
Medicare Plan Finder — for residents in California and ArizonaContact us today to set up an appointment with one of our Medicare advisors.
Call 909-530-0816